European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment – Update 2019

European Dermatology Forum (EDF), European Association of Dermato-Oncology (EADO), European Organization for Research and Treatment of Cancer (EORTC)

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

A unique collaboration of multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with 1- to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumour thickness ≥1.0 mm or ≥0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team (“Tumor Board”). Adjuvant therapies in stage III/IV patients are primarily anti–PD-1, independent of mutational status, or dabrafenib plus trametinib for BRAF-mutant patients. In distant metastasis, either resected or not, systemic treatment is indicated. For first-line treatment, particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In particular scenarios for patients with stage IV melanoma and a BRAF-V600 E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harbouring a BRAF-V600 E/K mutation, this therapy shall be offered in second-line. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future.

Original languageEnglish
JournalEuropean Journal of Cancer
Volume126
Pages (from-to)159-177
ISSN0959-8049
DOIs
Publication statusPublished - Feb 2020

    Fingerprint

Keywords

  • Adjuvant treatment
  • Cutaneous melanoma
  • Excisional margins
  • Interferon-α
  • Metastasectomy
  • Sentinel lymph node dissection
  • Systemic treatment
  • Tumour thickness

Cite this

European Dermatology Forum (EDF), European Association of Dermato-Oncology (EADO), European Organization for Research and Treatment of Cancer (EORTC) (2020). European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment – Update 2019. European Journal of Cancer, 126, 159-177. https://doi.org/10.1016/j.ejca.2019.11.015